Challenges of matrix support as educational practice: mental health in primary healthcare / Desafios do apoio matricial como prática educacional: a saúde mental na atenção básica / Desafíos del apoyo matricial como práctica educativa: la salud mental en la atención básica

This study investigated the educational dimension of matrix support practices for mental health within primary care. Using an interpretative-explanatory qualitative approach, professionals involved in matrix support for mental health in a municipality in the state of São Paulo, Brazil, were interviewed. The data were compared with matrix support frameworks with two pedagogical trends: directive and constructivist. The analysis on this content was incorporated with the interviews and two themes could be identified: “matrix supporter’s profile”, and “challenges for construction of matrix supporter’s practice.” The subjects’ perceptions regarding supporters’ competence profiles were coherent with matrix support assumptions, whereas their educational practices related mainly to the directive trend. The challenge of implementing constructivist practice was only partially recognized, since this requires a critical and transformative stance regarding the hegemonic educational practices within healthcare.

Trata-se de investigação sobre a dimensão educacional das práticas de apoio matricial (AM) em saúde mental na atenção básica. A partir de uma abordagem qualitativa, do tipo interpretativo-explicativo, foram entrevistados profissionais envolvidos com AM em saúde mental de um município do interior de São Paulo, Brasil. Esses dados foram confrontados com os referenciais de AM em duas tendências pedagógicas: diretiva e construtivista. A análise deste conteúdo foi incorporada às entrevistas e permitiu a identificação de duas temáticas: “perfil do apoiador matricial”; e “desafios para a construção da prática do apoiador matricial”. A percepção sobre o perfil de competência do apoiador mostrou-se coerente com os pressupostos do AM, ao passo que suas práticas educacionais apresentaram-se predominantemente vinculadas à tendência diretiva. O desafio para uma prática construtivista foi parcialmente constatado, uma vez que requer uma posição crítica e transformadora frente às práticas educacionais hegemônicas presentes na saúde.

Se trata de una investigación sobre la dimensión educativa de las prácticas de apoyo matricial (AM) en salud mental en la atención básica. A partir de un abordaje cualitativo, se entrevistaron profesionales envueltos en AM en salud mental de un municipio del interior de São Paulo, Brasil. Esos datos se confrontaron con los datos referenciales de AM en dos tendencias pedagógicas: directiva y constructivista. El análisis de este contenido se incorporó a las entrevistas y permitió la identificación de dos temáticas: “perfil del apoyador matricial” y “desafíos para la construcción de la práctica del apoyador matricial”. La percepción sobre el perfil de competencia del apoyador se mostró coherente con las presuposiciones del AM, sus prácticas educativas se presentaron predominantemente vinculadas a la tendencia directiva. El desafío para una práctica constructivista se constató parcialmente, puesto que requiere una posición crítica y transformadora ante las prácticas educativas hegemónicas presentes en la salud.

Critical Care In Korea: Present and Future

Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our contry is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty. To improve CCM in Korea, reimbursement of the government must be amended such that referral hospitals can hire sufficient number of qualified intensivists and nurses. For the government to address these urgent issues, public awareness of the role of CCM is also required.

Study of unmet need for family planning in Dar Assalam, Sudan 2001

In this descriptive study, the main objective was to determine the magnitude of unmet need for family planning among women of child-bearing age [15-49 years] in Dar Assalam. Using a detailed questionnaire, we studied 530 ever-married women selected randomly through a multistage sampling technique. Current use of contraception was 21.3%. Using the Westoff model, unmet need was 30.7%. Contraceptive pills were the most commonly used method, 92%. Knowledge on contraception was 61.3% for a single method and 23.4% > or = 2 methods. Knowledge was obtained mainly from relatives, 48.6%

Ambient noise strategy: a solution for noise control?

The British Government earlier this year undertook a consultation on its proposal, announced in the Rural White Paper, to develop an Ambient Noise Strategy in England. The proposals envisage a three phase approach: In phase 1 we would aim to establish three key sets of information: information on the ambient noise climate in the country--i.e. the number of people affected by different levels of noise, the source of that noise (road, rail, airports and industry) and the location of the people affected, by producing noise maps of the main sources of noise; methods which the Government might use to assess the effects of noise--particularly regarding people's quality of life and tranquility; the techniques available to take action to improve the situation where bad or preserve it where good. In phase 2 we would aim to evaluate and identify options for prioritising the various alternatives from phase 1 in terms not only of costs and benefits but also time-scales and synergies and conflicts with other Government priorities including economic and social issues. An optimal policy reduces noise at lowest net cost, whilst capturing as many synergistic benefits, and minimising any potentially adverse impacts. Decision makers need to ensure that the impacts of the noise policies do not cost society more than the benefits expected. A recent study undertaken by the Government, looked at how a cost-benefit type framework could be used, with noise maps, to help inform such decisions. Finally, in phase 3, the Government would need to agree on the necessary policies to move towards the desired outcome--i.e. the National Ambient Noise Strategy itself. The results of the consultation are expected to be published later this year.

Community context of health system development: implications for health sector reform in Pakistan

To describe local sociopolitical and organizational factors that influence health system development in Karachi, Pakistan, we conducted participant observation while working with health providers and communities in one urban district to reorient services towards a primary health care district health system. We found that the community characteristics, particularly the diverse socialpolitical and cultural make-up and organizational complexity that involved multiple levels of government, influenced efforts towards collaboration and shaped the development of the health system. We conclude that for effective implementation of health sector reform there is a need to comprehend fully the community context and complexity of existing health service provision

Reproductive and child health programme.

Reproductive and Child Health Programme is an integrated and comprehensive programme based on realistic decentralised area specific microplanning tailored to meet the local needs. There is adequate emphasis on provision of good quality of services under the programme. The present paper traces the genesis and evolution of the RCH programme followed by its objectives, strategies and components. Various mechanisms for the implementation, monitoring and evaluation of the programme are discussed. The programme is analysed critically and suggestions for improvement are provided.

Information needs assessment for HIV/AIDS and STIs in the Eastern Mediterranean Region

We assessed information needs about HIV/AIDS and sexually transmitted infections [STI] in the Eastern Mediterranean Region by surveying a sample of people considered knowledgeable about the subject. Respondents felt that information on certain areas of HIV/AIDS/STIs was much needed. Health care workers were perceived to see a high need for information and services generally. Religious and community leaders were perceived to see less need for some information and services [such as condom promotion, sex education for young people]. All groups were perceived to see a need for education and services for people living with AIDS and drug users. Television and radio were considered the best channels for health education while training was seen as the most effective method for information exchange

Tuberculosis and HIV in the Eastern Mediterranean Region

Tuberculosis [TB] is an important public health problem in the Eastern Mediterranean Region of the World Health Organization. Every year the disease kills 136,000 people and affects 630,000 more. HIV is the most significant risk factor for progression from subclinical infection with Mycobacterium tuberculosis to active TB. Although the HIV/AIDS threat in the Region appears to be relatively modest and so far there has been no evidence of an impact of HIV on TB epidemiology in the Region, there is a need to jointly address HIV infection and TB more effectively. In this paper the TB situation in the Region and the measures being taken to combat it are outlined. The impact of HIV infection on TB and the repercussions this could have on theTB situation in the Region are also discussed. Actions that are needed to tackle this double burden are suggested

Blood transfusion services: organization is integral to safety.

There are six steps to a safe blood transfusion service. The primary steps are: (i) a national policy for the blood transfusion service with time-bound programmes; (ii) a centrally coordinated, structured and organized blood transfusion service for a country/state under a defined authority; and (iii) a blood transfusion service based on an organized voluntary blood donor programme. The complementary steps are: (i) screening blood for transfusion-associated infections (TAI) appropriate to the region; (ii) rational use of available blood; and (iii) qualified personnel to head and manage the blood transfusion service. None of these steps are in place in India and the high incidence of TAI in our patients is a consequence of this deficiency. Lack of understanding of the issues related to a safe blood transfusion service has led to an emphasis on screening donor blood for infections as a means of ensuring safe blood transfusion. Screening donor blood for TAI without implementing the critical primary steps has little impact, as evidenced by the high levels of post-transfusion hepatitis which ranges from 7% for hepatitis B and C combined in patients receiving approximately 1-7 units of blood to > 50% and > 30%, respectively, for patients receiving multiple transfusions. Basic licensing standards for blood banks with regard to space, and the quality and quantity of medical staff have remained unchanged over the past three decades. This compounds the problem and society pays the price.

Bioterrorism: a threat for which we are ill prepared.

Of the weapons of mass destruction, the biological ones are the most feared and bioterrorism has become one of the most vicious threats to civilized society in recent times. Biological weapons have been sporadically used for centuries. Despite international regulations, there has been a global re-emergence of the threat of biological warfare. As many as 17 countries are suspected of either including or developing biological agents in their weapons programmes. In the past decade, a number of terrorist organizations with access to bioweapons technology have emerged. Current surveillance systems may be inadequate to detect biological attacks. The onset of illness is often delayed, thus the timing and location of such an event may be extremely difficult to identify. We are unfamiliar with most of the agents of biological warfare and are ill-equipped to handle the consequences of such an attack. In addition, there is no apparent coherent policy to handle a biological terrorist incident. Given the enormity of what is possible in the event of a biological attack, we must be prepared to detect, diagnose, epidemiologically characterize and respond appropriately to biological weapons. Of the potential biological weapons, smallpox and anthrax pose the greatest threats.